Provider Demographics
NPI:1366993321
Name:D BALDER MD PLLC
Entity type:Organization
Organization Name:D BALDER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:228-265-5945
Mailing Address - Street 1:11070 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3852
Mailing Address - Country:US
Mailing Address - Phone:228-265-5945
Mailing Address - Fax:228-284-1580
Practice Address - Street 1:11070 DAVID ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3852
Practice Address - Country:US
Practice Address - Phone:228-265-5945
Practice Address - Fax:228-284-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA042354MD174400000X
MS21885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty